CME ACTIVITY
Denied Due to Lack of Medical Necessity:
Preventing & Responding to Insurance Denials for PANS/PANDAS Treatments
Presented by Elizabeth Irias, LMFT
Hosted by PANDAS Physicians Network
START ACTIVITY
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Denied Due to Lack of Medical Necessity: Preventing & Responding to Insurance Denials for PANS/PANDAS Treatments
Target Audience:
Physicians who accept in-network or out-of-network insurance benefits, Utilization Review Professionals, Clinical Managers, Nurses, Pediatricians, Family Physicians, Nurse Practitioners, Physician’s Assistants
Learning Objectives
Participants will be able to:
- Compare and contrast state/federal definitions of Medical Necessity to definitions supplied by third-party payors (insurance companies)
- Demonstrate how to effectively use state law/case law and research studies during case shaping or peer-to-peer calls as a means to advocate for medically-necessary treatment
- Develop strategies for improving peer to peer and/or appeal outcomes
Description:
This presentation offers key information about managed care systems and Utilization Review-related laws, including discussion about the use of peer-reviewed studies and the effect of clinical documentation on peer-to-peer outcomes. It is designed to sharpen the advocacy skills of treating physicians and medical teams, thereby helping patients receive appropriate managed care treatment authorizations. This presentation provides examples of various Utilization Review-related laws in densely-populated states, and also provides guidance about how to access these laws in relevant jurisdictions. It provides the framework for strategies for use during insurance authorization reviews; this presentation is not legal advice. This presentation provides the framework for strategies for use during insurance authorization reviews; this presentation is not legal advice.
Denied Due to Lack of Medical Necessity: Preventing & Responding to Insurance Denials for PANS/PANDAS Treatments
Estimated Time for Completion: 60 minutes
Dates:
Release Date: March 16, 2023
Credit Available
Physicians: 1.00 (60 minutes)
Physician Assistants: 1.00 (60 minutes)
Nurses: 1.00 (60 minutes)
JOINT ACCREDITATION STATEMENT
DISCLAIMER: Accreditation refers to educational content only and does not imply ANCC, or PIK endorsement of any commercial product or service.
DISCLOSURE INFORMATION: Projects In Knowledge® adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CE activity, including faculty, planners, reviewers or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests)*. All relevant conflicts of interest have been mitigated prior to the commencement of the activity.
In the past 24 months, Elizabeth Irias, LMFT has not had any financial relationships with any ineligible companies.
JOINT ACCREDITATION STATEMENT
In support of improving patient care, this activity has been planned and implemented by PANDAS Physicians Network and Projects In Knowledge®.. Projects In Knowledge is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physicians
Projects In Knowledge® designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physician Assistants
Projects In Knowledge® has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 Credit(s)™. Approval is valid until 04/30/2022. PAs should only claim credit commensurate with the extent of their participation.
Nurses
Upon completion of this course, participants will be awarded 1.0 nursing contact hour(s). Joint Accreditation Nursing Provider Number: 4008235
DISCLAIMER:
Accreditation refers to educational content only and does not imply ANCC, or PIK endorsement of any commercial product or service.
DISCLOSURE INFORMATION: Projects In Knowledge® adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CE activity, including faculty, planners, reviewers or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests)*. All relevant conflicts of interest have been mitigated prior to the commencement of the activity.
Thank you to @Point of Care™ and Projects in Knowledge for their continued generosity.